Provider Demographics
NPI:1346423605
Name:IZUMI, HARUYO (ATC)
Entity Type:Individual
Prefix:MS
First Name:HARUYO
Middle Name:
Last Name:IZUMI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 BRIDGE AVE
Mailing Address - Street 2:APT 311
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1875
Mailing Address - Country:US
Mailing Address - Phone:563-468-1259
Mailing Address - Fax:
Practice Address - Street 1:518 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2829
Practice Address - Country:US
Practice Address - Phone:563-333-6061
Practice Address - Fax:563-333-6239
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer